Provider Demographics
NPI:1790436251
Name:CAMAHALAN, IAN I (PTA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:I
Last Name:CAMAHALAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 JERRY TARKANIAN WAY UNIT 19205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-0013
Mailing Address - Country:US
Mailing Address - Phone:702-727-7738
Mailing Address - Fax:
Practice Address - Street 1:5175 JERRY TARKANIAN WAY UNIT 19205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-0013
Practice Address - Country:US
Practice Address - Phone:702-381-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant